title: Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region.
abstract: Inhabitants of deprived neighbourhoods are at higher risk of coronary heart disease. In this study we investigate the hypothesis that social inequalities at neighbourhood level become already manifest in subclinical coronary atherosclerosis, as defined by electron-beam computed tomography derived measures. Coronary artery calcification was assessed as a marker of atherosclerosis in a population based sample of 4301 men and women (45-75 years) without a history of coronary heart disease. Participants lived in three adjacent cities in Germany and were examined between 2000 and 2003 as part of the Heinz Nixdorf Recall Study. Individual level data was combined with neighbourhood level information about unemployment, welfare and living space per inhabitant. This dataset was analysed with descriptive and multilevel regression methods. An association between neighbourhood deprivation and subclinical coronary calcification was observed. After adjustment for age and individual socioeconomic status male inhabitants of high unemployment neighbourhoods had an odds ratio of 1.45 (1.11, 1.96) of exhibiting a high calcification score (>75th percentile) compared to men living in low unemployment areas. The respective odds for women was 1.29 (0.97, 1.70). Additional explorative analyses suggest that clustering of unhealthy lifestyles in deprived neighbourhoods contributes to the observed association. In conclusion, findings suggest that certain neighbourhood characteristics promote the emergence of coronary atherosclerosis. This might point to a pathway from neighbourhood deprivation to manifest coronary heart disease.
authors.affiliation: Department of Medical Sociology, Heinrich-Heine-University, PO 101007, Duesseldorf 40001, Germany. dragano@uni-duesseldorf.de
authors.forename: Nico
authors.initials: N
authors.lastname: Dragano
authors.forename: Barbara
authors.initials: B
authors.lastname: Hoffmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Stang
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.forename: Pablo E
authors.initials: PE
authors.lastname: Verde
authors.forename: Simone
authors.initials: S
authors.lastname: Weyers
authors.forename: Stefan
authors.initials: S
authors.lastname: Möhlenkamp
authors.forename: Axel
authors.initials: A
authors.lastname: Schmermund
authors.forename: Klaus
authors.initials: K
authors.lastname: Mann
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Johannes
authors.initials: J
authors.lastname: Siegrist
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data*; D011204:Poverty Areas; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D014504:Urban Health